title: Use of tissue expander in pelvic Ewing's sarcoma treated with radiotherapy.
abstract: BACKGROUND
  The local treatment option for pelvic Ewing sarcoma (ES) remains uncertain and challenging as surgery is often disabling while radiotherapy alone has a higher risk of local recurrence but not necessarily a worse survival. The aim is to analyse the outcome of patients with pelvic ES after radiotherapy as the primary local treatment in combination with a temporary intrapelvic surgically placed tissue expander (TE) to reduce bowel complications.
  
  
  METHODS
  20 patients were retrospectively analysed. All patients had neoadjuvant and adjuvant chemotherapy. We identified survival, time to develop local recurrence and metastasis, dose of radiotherapy administered, local complications related to the use of the tissue expander and bowel effects of radiotherapy.
  
  
  RESULTS
  The median follow-up was 41 months. 14 patients were stage IIb and six stage III. There were no problems after insertion of the TE and only one patient who developed mild diarrhoea. Local recurrence occurred in six patients. At the last follow-up 12 patients have died from sarcoma, five are disease free and three have had recurrent disease.
  
  
  CONCLUSIONS
  In this paper we reviewed pelvic Ewing sarcoma with all the special considerations that this entails. We think that tissue expander can be safely used when radiotherapy is chosen to treat pelvic ES. It does appear to prevent bowel problems and is a low morbidity procedure. New treatment approaches should be considered to give a chance of cure to those patients with "bad prognostic" pelvic ES.
authors.affiliation: Hospital Infanta Cristina, Avenida Nueve de Junio, 2, 28981 Parla, Madrid, Spain. Electronic address: israel.perezmun@salud.madrid.org.
authors.forename: I
authors.initials: I
authors.lastname: Pérez-Muñoz
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK. Electronic address: robert.grimer@nhs.net.
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK.
authors.forename: D
authors.initials: D
authors.lastname: Spooner
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Carter
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK.
authors.forename: R
authors.initials: R
authors.lastname: Tillman
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK. Electronic address: seggy.abudu@nhs.net.
authors.forename: A
authors.initials: A
authors.lastname: Abudu
authors.affiliation: The Royal Orthopaedic Hospital Oncology Service, Bristol Rd S, Northfield, Birmingham B31 2AP, UK. Electronic address: lee.jeys@nhs.net.
authors.forename: L
authors.initials: L
authors.lastname: Jeys
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010384:Pelvic Bones; D011832:Radiation Injuries / Q000517:prevention & control*; D011835:Radiation Protection / Q000379:methods*; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000532:radiotherapy*; D015625:Tissue Expansion Devices; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bowel effects of radiotherapy; Pelvic Ewing sarcoma; Tissue expander